The Stomarium Dental Journal of the Faculty of Dentistry at the American University is an annual publication that gathers the results of research work stemming from the academic activities of professors, undergraduate and postgraduate students, as well as national and international researchers who are of interest to the academic community. The journal aims to disseminate scientific information arising from research in the field of Dentistry.
Impact evaluation of an educational intervention on oral hygiene in vulnerable communities in Somoto, Nicaragua. Results of the O’Leary Index 2023–2024.Impact evaluation of an educational intervention on oral hygiene in vulnerable communities in Somoto, N
Objective: To evaluate the impact of a multimodal educational and clinical intervention on the O'Leary Index in a cohort of children from vulnerable communities in Somoto, Nicaragua, through a one-year longitudinal follow-up (2023–2024). Methodology: A single-group quasi-experimental study with a pretest-posttest design was conducted. The sample included 51 children selected by convenience who completed the intervention protocol. The normality of the differences was verified using the Shapiro-Wilk test (p: 0.729). Bivariate analysis was performed using Student’s t-test for paired samples. Additionally, McNemar’s test and a post-hoc statistical power analysis were conducted to validate the sample size. Results: A statistically significant decrease was observed in the average O'Leary Index, falling from 50.61% (±21.93) in 2023 to 36.36% (±17.97) in 2024 (Difference: 14.25%; t: 3.341; p: 0.0016). At the individual level, 64.7% of participants significantly improved their oral hygiene (x²: 4.41; p: 0.035). The study achieved a statistical power of 90.6% (d: 0.467), confirming that the sample size was sufficient to detect the program’s positive impact. Conclusions: The intervention carried out by the UAM-INPRHU proved highly effective, resulting in a substantial improvement in the oral health of a vulnerable population. It is concluded that the mobile clinic model is a successful tool for promoting equity; it is recommended that the frequency of these interventions be increased to maximize their impact and ensure the sustainability of the observed hygiene habits.
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This article presents a review of the scientific literature on dental anomalies characterized by the union of tissues between two dental organs, such as fusion and concrescence, as well as the positional anomaly known as dental transposition. In addition, a clinical case is reported showing root union between a maxillary third molar and the ipsilateral first molar on its buccal aspect, a finding compatible with either dental fusion or concrescence. The differences between these diagnostic entities are analyzed, and the criteria for establishing a definitive diagnosis are discussed. In the reported case, an ectopic position of the maxillary right third molar germ was identified through panoramic radiography in a patient referred to oral and maxillofacial surgery for third molar extraction before orthodontic treatment. For treatment planning, cone-beam computed tomography (CBCT) was indicated, revealing the dental anomaly and the high risk of damage to the maxillary right first molar if extraction were attempted. Therefore, surgical extraction of the affected third molar was contraindicated. The relevance of this case lies in the value of three-dimensional imaging for identifying such anomalies and for establishing an appropriate treatment plan.
Outcome of the use of total and removable prostheses in a private clinic in the city of Managua 2021-2023
The article focuses on the use of dental prostheses, artificial devices that replace natural teeth to improve oral health and quality of life. Objective: quantify the frequency of use and adaptation to removable full and partial dentures in patients at a private clinic in Managua during 2021-2023, analyzing the association between the type of prosthesis and its effective use. Method: A quantitative, descriptive, cross-sectional study was conducted with a sample of 80 patients, obtained through non-probabilistic convenience sampling. Data were collected from clinical records and analyzed using descriptive statistics and chi-square tests (p<0.05). It was found that 56.25% of the prostheses were removable partial dentures and 43.75% were complete dentures. One hundred percent of removable partial denture users used them effectively, while 11.43% of complete denture wearers did not use them, with a predominance in women. Results: The quantitative results indicate significantly greater acceptance and use of removable partial dentures. Conclusion: although most patients with complete dentures use them (88.57%), removable partial dentures show a perfect usage rate, suggesting greater comfort. It is recommended that clinical follow-up and patient education be personalized to optimize the adaptation and functionality of both types of dentures.
Comparative analysis between glass ionomer and alcacites using compressive strength tests. An in vitro study
Objective: To compare the compressive strength of the glass ionomer cement GC Fuji IX GP and Cention N (Ivoclar Vivadent) through in vitro testing using standardized specimens, to identify the material with superior mechanical performance. Methodology: A total of 40 standardized cylindrical specimens were prepared, with a height of 12 mm and a diameter of 6 mm, following each manufacturer’s specifications, and subsequently stored in distilled water. The samples were divided into two experimental groups: the first group consisted of 20 glass ionomer specimens, and the second group comprised 20 alkasite specimens. All samples were tested in a laboratory using a universal testing machine. A TRITECH50 50 kN (Wykeham Farrance, Controls Group) device was used to subject the 40 specimens to compressive strength testing. Results: A statistically significant difference was found between the compressive strength values of the two materials (p < 0.001). The analysis clearly showed that the alkasite exhibited higher compressive strength (144.83 MPa) compared to the glass ionomer (40.98 MPa), with a large effect size (Cohen’s d = 5.53). Conclusions: Cention N alkasite (Ivoclar Vivadent) demonstrated significantly higher compressive strength compared to GC Fuji IX GP glass ionomer, with a mean difference of approximately 104 MPa (p < 0.001).
Cytotoxic Effects of an Ascorbic Acid–Modified Orthodontic Wax on Human Gingival Fibroblast Cultures
Introduction: The incorporation of bioactive compounds into dental materials requires the evaluation of their cellular biocompatibility. In this study, an orthodontic prescription wax was modified by incorporating ascorbic acid (vitamin C), and its cytotoxic effects on human gingival fibroblasts of mesenchymal origin (hGFs) were evaluated in vitro. Materials and Methods: A mixture containing vitamin C was prepared from crushed effervescent tablets combined with orthodontic wax, using dimethyl sulfoxide (DMSO) as a solvent to achieve dissolution. hGFs were cultured and exposed to different dilutions of the wax–vitamin C stock solution (0–1 g/mL). Cell viability was determined using an MTT assay. Results: The highest ascorbic acid concentration tested induced complete fibroblast cell death. At intermediate and low concentrations, cells survived and exhibited normal morphology, indicating reduced cytotoxicity with decreasing dosage. The concentration considered optimal, with minimal cytotoxic effect, was approximately 0.0078 g/mL, at which the highest number of viable cells was observed. Conclusions: Orthodontic wax enriched with vitamin C did not exhibit cytotoxic effects in a dose-dependent manner, and the safe concentration was determined to be ≤ 0.0078 g/mL. These findings suggest the potential for incorporating vitamin C at appropriate doses into orthodontic biomaterials to leverage its therapeutic properties.
Frequency and characteristics of intraoperative complications during endodontic treatments performed by postgraduate residents at the American University
Objective: To identify the most frequent complication during endodontic procedures performed by postgraduate residents in the Endodontics Specialty Program. Method: A descriptive cross-sectional study was conducted in the postgraduate dental clinics at Universidad Americana. The evaluation was based on the analysis of periapical radiographs obtained using a phosphor plate and examined with the DBSWIN 5.16.1 software. Additionally, patient records and data collection forms completed by the operators were reviewed. Results: A total of 157 root canal treatments performed by residents were analyzed, of which 19 teeth (12.10%) presented intraoperative complications. Most complications occurred during the cleaning and shaping stage (57.89%) and were predominantly located in the apical third of the root canal (71.15%). Complications were more common in molars than in anterior teeth. The most frequent complication was underfilling, accounting for 32% of the cases with complications. Conclusion: Underfilling was the most common intraoperative complication in root canal treatments performed by postgraduate residents, highlighting the need to strengthen quality control during the obturation phase, particularly in multirooted teeth.
Case report: Presence of Dental Gemination in a Patient in the Prepubertal Growth Stage and Its Impact on Gingival Health and Dental Occlusion
Objective: To analyze the anatomical characteristics of dental gemination and its impact on gingival health and occlusion through a detailed clinical case. Methodology: A descriptive-qualitative study conducted within the context of orthodontic clinical practice. A prepubertal patient with dental gemination was included, and the morphological characteristics of the geminated teeth, as well as their impact on gingival health and occlusion, were evaluated. An extensive analysis was performed using study models and radiographs to observe tooth eruption and alignment discrepancies. Results: The geminated tooth exhibited inflammation in the gingival tissues due to plaque accumulation, which resulted from difficulties in maintaining proper oral hygiene, exacerbated by the tooth’s irregular shape. Conclusion: The double crown characteristic of dental gemination promotes plaque accumulation, thus increasing the risk of gingival inflammation. Alterations such as crowding, tooth deviation, and changes in malocclusion were identified, all of which require orthodontic intervention.
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Conservative Treatment of a Unicystic Ameloblastoma: Case Report with Four-Year Follow-Up
Unicystic ameloblastoma is a benign but locally aggressive odontogenic tumor that presents as a cystic cavity with or without luminal proliferation. This report presents the case of a 21-year-old male patient diagnosed with unicystic ameloblastoma, extending from the mesial aspect of tooth 37 to the mandibular angle and ramus, moving 38 teeth in a caudal direction. The patient was treated with marsupialization for three years, followed by enucleation along with the extraction of teeth 38 and 37 and peripheral osteotomy. Clinical and radiographic follow-ups were performed over a period of four years, showing no evidence of recurrence or tumor persistence. This article describes a conservative treatment alternative for managing unicystic ameloblastoma, highlighting the importance of clinical and radiographic follow-up.
Case Report of a Free Gingival Graft to Improve Keratinized Gingiva Around Implants
This clinical report describes the surgical management of a patient with a deficiency of keratinized tissue around implants placed in positions 3.5 and 3.6. Insufficient keratinized tissue can compromise peri-implant health, hinder oral hygiene, and increase the risk of inflammation and marginal bone loss. To address this condition, a free gingival graft (FGG) harvested from the palate was performed to enhance the amount of keratinized gingiva and improve peri-implant conditions. The procedure included careful surgical planning, preparation of the recipient site, and suturing of the graft in place. Specific postoperative instructions were provided, and short- and mid-term follow-ups were conducted to evaluate graft integration and esthetic and functional outcomes.
Effect of grape seed extract and essential oil on enamel bonding strength post-treatment of teeth whitening with 35% hydrogen peroxide
Background: Immediately after tooth whitening, the bond strength between the adhesive materials and enamel decreases, it is necessary to wait between 7 to 21 days for adhesive procedures. Objective: To evaluate the bonding resistance to enamel exposed to different antioxidants after whitening treatment with 35% hydrogen peroxide. Materials and methods: Bovine teeth were used. All the specimens received whitening treatment with 35% hydrogen peroxide, two applications of 15 minutes each were made, for two sessions every 7 days. After the treatment, the specimens were randomized to receive the different antioxidants for 10 minutes on the enamel. evaluating four groups: grape seed oil (ASU), 5% grape seed extract (ESU); negative control (bleaching without antioxidant) and positive control (without bleaching and without antioxidant). Subsequently, the restorative treatment with fluid resin was carried out. The micro shear test was used on the universal machine. The ANOVA test was used to compare the binding resistance values ​​of the different groups evaluated, assuming normality. Results: It was found that the groups exposed to antioxidants presented the lowest values ​​of binding resistance when compared with the group without bleaching, without significant differences between the fixed oil of ESU 8.09 (3.24) MPa and the seed extract grape 8.08 (3.79) MPa (p <0.05). Conclusions: The extract and essential oil of grape seed diminishes the resistance of bonding to the enamel after whitening treatment with hydrogen peroxide to 35%.
Comparison of the Survival Rate of Two High-Viscosity Glass Ionomer Cements in Class II Cavities Using the Atraumatic Restorative Technique – Faculty of Dentistry, UAM (March 2023 - May 2024)
The aim of this study is to evaluate the survival rate of restorations made with two high-viscosity glass ionomer cements (Fuji IX, GC and Ketac Molar Easy Mix, 3M) applied as a restorative material using the atraumatic restorative technique (ART) in Class II cavities of primary molars, assessed five months after placement. The research is experimental and quantitative in nature. The initial sample consisted of 22 pediatric patients with 27 Class II cavities to be treated, aged between 5 and 9 years, with active carious lesions located on the proximal surfaces of primary molars. However, the final sample included 19 patients with a total of 25 restorations. Clinical diagnosis was performed using the international caries detection and assessment system ICDAS. For the assessment of glass ionomer restorations, the criteria of Frencken and Holmgren were applied. For statistical analysis, Chi-square tests, Relative Risk, and Odds Ratio were used. From the aforementioned tests, it is concluded that the risk of achieving a “satisfactory” outcome is slightly higher when using Fuji IX, GC compared to Ketac Molar, 3M. Although the statistical analysis suggests that the risk of obtaining a satisfactory result is slightly greater for Fuji IX, GC compared to Ketac Molar, 3M, the observed differences are not statistically significant.
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Evaluation of Digital Bite Registration in Maximum Intercuspidation: Description of Different Intraoral Scanner Systems
Objective: The aim of this observational and descriptive study is to evaluate virtual interocclusal recordings (VIR) with three different intraoral scanner systems by analyzing the results with occlusal heat maps and deviation analysis between models to determine if variances are found between them. Methodology: Three different intraoral scanners (IOS) available from the faculty were used being: Primescan from Dentsply Sirona, Aoralscan 3 from Shining 3D Dental and Wireless i700 from Medit. Each scanner was previously calibrated and digital impressions were taken in a single patient with non-consecutive interventions. Subsequently, virtual interocclusal recording (IVR) was performed at maximum intercuspation (MI) while maintaining normal or average force. Once the impressions were taken, occlusal heat maps were evaluated and deviations between models were assessed. Results: In this study, mean force was chosen for each RIV, however, it can be noted that at the time of calculating the coordinates, the algorithm of each scanner presented different intensities and surface contact areas. Regarding the deviations, the statistical tests indicate that all mean differences are within acceptable tolerance. Conclusions: All scanners successfully identified the contact points when compared with intraoral tests. Exporting the files and analyzing them in external software is required to appreciate the differences where the intensity of the contact points and contact areas vary between each scanner. The deviations between the digital impressions are not clinically or practically significant.
Primary closure of unilateral cleft lip. Case report
The cleft lip is the most common congenital malformation, which affects structures of the face and oral cavity, due to its characteristics, it implies multidisciplinary management, where the specialist surgeon is one of the relevant components due to the variety of surgical procedures that the patient requires repair of the anomalies present in said primary condition. Objective: To Report the surgical techniques performed in the primary closure of five patients with unilateral cleft lip, according to the systematic surgical protocol used. Material and Method: A descriptive study, case report type, with a qualitative approach, and cross-sectional. The surgical procedures are described in five pediatric patients, younger than 12 months, diagnosed with unilateral cleft lips, operated on during the year 2022, using the Fisher technique and nasal reconstruction for primary closure. The five patients were evaluated individually according to the initial severity index. Results: The immediate postoperative period of five patients with unilateral, non-syndromic cleft lips is shown, in whom a surgical technique for primary closure was performed, based on the anatomical subunits of the lip and nose, described by Fisher, since 2004, which allowed Minimize the visibility of postoperative scars, being essential to obtain satisfactory aesthetic results. Conclusions: For satisfactory primary closure in patients with unilateral cleft lip, the Fisher technique is recommended due to its main advantages, in combination with primary reconstruction of the nasal floor and closure of the alveolar fissure, recommended surgical procedures to achieve satisfactory results in the immediate postoperative period.
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Use of digitally designed open-field static surgical guide for fully guided placement of dental implants: A case report
Purpose: Correct positioning and angulation of dental implants is one of the keys to successful treatment. In this report we will show the use of an open-field surgical guide system, digitally designed and additively manufactured with a 3D printer. Among its main advantages is that it allows us to plan prior to surgery the position of the implant in its three dimensions within the alveolar bone, oriented prosthetically using a diagnostic wax-up of the future prosthesis as a reference. This facilitates the placement of immediate provisionals and fewer adjustments in the final prosthesis. On the other hand, it allows us to move away from adjacent anatomical structures that we must avoid, such as nerves, blood vessels, paranasal sinuses, roots of neighboring teeth, among others. Methodology: We will describe the planning process of prosthetic guided implants, as well as the design of the surgical guide. We will evaluate the seating in the mouth after fabrication, surgery time and patient comfort. Results: The surgical guide was successfully impressed with adequate seating in the mouth. The surgery was minimally invasive, with no flap. It was also of short duration, the whole process was performed in no more than 35 minutes. Patient comfort was high transoperative and postoperatively. The final position of the implants coincided with the digitally planned position. Conclusions: We can conclude that the open-field surgical guide system can be used as a successful tool for the adequate placement of dental implants; respecting the appropriate parameters from implant planning (It is recommended to respect the safety zone) to the design and impression of the guide.
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Tuberculated Mesiodens: Report of a case in a pediatric patient
Mesiodens are supernumerary teeth that are commonly seen in the maxillary midline, between the central incisors. It is considered one of the commonly observed dental abnormalities in children. Given their high frequency, general dentists should be aware of the signs and symptoms of mesiodens and their appropriate treatment. This case report describes a 7-year-old boy who presented clinical and radiographic findings of a tuberculate supernumerary tooth in quadrant 2. On clinical examination, the erupted supernumerary tooth was observed at the level of the maxillary midline and clinical absence of the teeth 6.1 and 2.1. The radiographic examination shows the presence of the dental piece 2.1, which was included. The patient refers in his family medical history that his father has drug addiction, mother who suffered from leukemia and siblings with supernumerary teeth. After carrying out an adequate anamnesis and a correct clinical and radiographic diagnosis, it was decided to approach the case surgically, on an outpatient basis in the clinics of the American University. The aim of this article is to report the case of a tuberculous mesiodens in a pediatric patient with mixed dentition, inform about its shape, differential diagnosis and approach, in order to demonstrate the differentiate from this one to other teeth abnormalities of shape.
Compound odontoma: Case report in a child patient
The odontoma is one of the most frequent benign odontogenic tumors within the jaws (26-70%). It represents a ‘‘Anomaly of the development of the dental structure.’’ Composed of a mixture of odontogenic cells that form dentin and enamel. It presents normal cells and tissues, but with a defective structure. They are classified into compound and complex odontomas, being asymptomatic lesions of multifactorial etiology. Its treatment is surgical and periodic controls, although its recurrence is rare. Furthermore, a case of a 7-year-old female patient who attends the Pediatric Dentistry clinic of the American University is presented. The patient has an increase in volume in the vestibular region in the second quadrant, between the canine and the first upper primary molar. On clinical inspection, the absence of the dental organ (OD) is verified 6.3. In the imaging examination, a radiopaque lesion compatible with the radiographic description of an odontoma was observed, associated with upper temporal canine (6.3), upper lateral incisor (6.2) and permanent canine (2.3) that are outside the plane of dental occlusion. Subsequently, as an auxiliary method, Cone Beam tomography was used, in where the field of study was visualized, which facilitated the decision in the integral management of the case. It was decided to remove the lesion with its histopathological study, resulting in compound odontoma. The objective of this article is to describe the clinical and imaging characteristics of the case, as well as its surgical approach and comprehensive management.
Oral Manifestations in patients with Rheumatic Diseases, treated at a private rheumatologic clinic in the city of Managua 2022-2023
Rheumatological diseases are characterized by the loss of immunological tolerance, that is, the body’s ability to recognize itself. There are different mechanisms that are involved in its pathophysiology, such as the high production of autoantibodies and acute phase reactants, which can cause direct damage at a systemic level, among these are: systemic lupus erythematosus (SLE), rheumatoid arthritis (RA) and Sjögren’s syndrome (SS). Objective: Determinate the prevalence of oral manifestations in patients with rheumatological diseases and describe their sociodemographic characteristics. Materials and Methods: A descriptive study was carried out, with a mixed paradigm, with an exploratory sequential approach, through a documentary review of medical records of patients with rheumatological diseases and by applying an interview to a rheumatology specialist. Once the information was obtained, a qualitative analysis of the investigated categories was carried out. The total number of medical records corresponds to 83, of which 36 met the inclusion criteria, who were diagnosed with rheumatological diseases in a private clinic by subspecialist Dr. Deyanira Reyes. Conclusion: The prevalence of oral manifestations in patients with rheumatological diseases is 43%, of which 97% is female and 3% male. Most were between the second and fifth decade of life. The most frequent rheumatological diseases are Fibromyalgia 33%, systemic lupus erythematosus (SLE) 23%, rheumatoid arthritis (RA) 19%, Sjögren syndrome (SS). The most frequent oral manifestations are xerostomia, aphthous ulcers, temporomandibular dysfunction (TMD), dysphagia and periodontitis.
Power and irradiance generated by the photoactivation lamps used in the clinical area of the Dentistry Faculty at the American University (UAM)
The use of photoactivation lamps is essential in dentistry to ensure the adhesion of light-activated polymeric materials. The quality of light influences polymerization, a crucial step in dental treatments. Therefore, these lamps must provide the required properties for these materials. Inadequate light can negatively affect treatments. Objective: To evaluate the power and irradiance of photoactivation lamps in the School of Dentistry at the University of America. Problem: What is the power and irradiance produced by dental photoactivation lamps in the clinical area of the School of Dentistry at the University of America? Materials and Methods: The power (mW) and irradiance (mW/cm²) of thirteen lamps used in the clinical area and two external control lamps were measured. Readings were obtained using a digital radiometer, Bluephase® II Ivoclar, with the lamps placed on a stand and activated for ten seconds. Results: It was found that seven lamps had irradiance exceeding 300 mW/cm² at a distance of 0 mm, decreasing at greater distances. Twelve lamps recorded lower values than the control lamps. Lamps older than five years exhibited lower power and irradiance than newer ones. Conclusion: Smaller-diameter lamps had higher irradiance than larger-diameter lamps. Only four lamps in the clinical area exhibited an acceptable condition in terms of permanent and reversible damage. This study underscores the importance of light quality in dentistry.